Air pollution is hypothesized to be a risk factor for diabetes. Epidemiological evidence is inconsistent and has not been systematically evaluated.
We systematically reviewed epidemiological evidence ...on the association between air pollution and diabetes, and synthesized results of studies on type 2 diabetes mellitus (T2DM).
We systematically searched electronic literature databases (last search, 29 April 2014) for studies reporting the association between air pollution (particle concentration or traffic exposure) and diabetes (type 1, type 2, or gestational). We systematically evaluated risk of bias and role of potential confounders in all studies. We synthesized reported associations with T2DM in meta-analyses using random-effects models and conducted various sensitivity analyses.
We included 13 studies (8 on T2DM, 2 on type 1, 3 on gestational diabetes), all conducted in Europe or North America. Five studies were longitudinal, 5 cross-sectional, 2 case-control, and 1 ecologic. Risk of bias, air pollution assessment, and confounder control varied across studies. Dose-response effects were not reported. Meta-analyses of 3 studies on PM2.5 (particulate matter ≤ 2.5 μm in diameter) and 4 studies on NO2 (nitrogen dioxide) showed increased risk of T2DM by 8-10% per 10-μg/m3 increase in exposure PM2.5: 1.10 (95% CI: 1.02, 1.18); NO2: 1.08 (95% CI: 1.00, 1.17). Associations were stronger in females. Sensitivity analyses showed similar results.
Existing evidence indicates a positive association of air pollution and T2DM risk, albeit there is high risk of bias. High-quality studies assessing dose-response effects are needed. Research should be expanded to developing countries where outdoor and indoor air pollution are high.
Short-term exposure to air pollution has adverse effects among patients with asthma, but whether long-term exposure to air pollution is a cause of adult-onset asthma is unclear.
We aimed to ...investigate the association between air pollution and adult onset asthma.
Asthma incidence was prospectively assessed in six European cohorts. Exposures studied were annual average concentrations at home addresses for nitrogen oxides assessed for 23,704 participants (including 1,257 incident cases) and particulate matter (PM) assessed for 17,909 participants through ESCAPE land-use regression models and traffic exposure indicators. Meta-analyses of cohort-specific logistic regression on asthma incidence were performed. Models were adjusted for age, sex, overweight, education, and smoking and included city/area within each cohort as a random effect.
In this longitudinal analysis, asthma incidence was positively, but not significantly, associated with all exposure metrics, except for PMcoarse. Positive associations of borderline significance were observed for nitrogen dioxide adjusted odds ratio (OR) = 1.10; 95% CI: 0.99, 1.21 per 10 μg/m3; p = 0.10 and nitrogen oxides (adjusted OR = 1.04; 95% CI: 0.99, 1.08 per 20 μg/m3; p = 0.08). Nonsignificant positive associations were estimated for PM10 (adjusted OR = 1.04; 95% CI: 0.88, 1.23 per 10 μg/m3), PM2.5 (adjusted OR = 1.04; 95% CI: 0.88, 1.23 per 5 μg/m3), PM2.5absorbance (adjusted OR = 1.06; 95% CI: 0.95, 1.19 per 10-5/m), traffic load (adjusted OR = 1.10; 95% CI: 0.93, 1.30 per 4 million vehicles × meters/day on major roads in a 100-m buffer), and traffic intensity (adjusted OR = 1.10; 95% CI: 0.93, 1.30 per 5,000 vehicles/day on the nearest road). A nonsignificant negative association was estimated for PMcoarse (adjusted OR = 0.98; 95% CI: 0.87, 1.14 per 5 μg/m3).
Results suggest a deleterious effect of ambient air pollution on asthma incidence in adults. Further research with improved personal-level exposure assessment (vs. residential exposure assessment only) and phenotypic characterization is needed.
Ambient air pollution increases the risk of respiratory mortality, but evidence for impacts on lung function and chronic obstructive pulmonary disease (COPD) is less well established. The aim was to ...evaluate whether ambient air pollution is associated with lung function and COPD, and explore potential vulnerability factors.We used UK Biobank data on 303 887 individuals aged 40-69 years, with complete covariate data and valid lung function measures. Cross-sectional analyses examined associations of land use regression-based estimates of particulate matter (particles with a 50% cut-off aerodynamic diameter of 2.5 and 10 µm: PM
and PM
, respectively; and coarse particles with diameter between 2.5 μm and 10 μm: PM
) and nitrogen dioxide (NO
) concentrations with forced expiratory volume in 1 s (FEV
), forced vital capacity (FVC), the FEV
/FVC ratio and COPD (FEV
/FVC <lower limit of normal). Effect modification was investigated for sex, age, obesity, smoking status, household income, asthma status and occupations previously linked to COPD.Higher exposures to each pollutant were significantly associated with lower lung function. A 5 µg·m
increase in PM
concentration was associated with lower FEV
(-83.13 mL, 95% CI -92.50- -73.75 mL) and FVC (-62.62 mL, 95% CI -73.91- -51.32 mL). COPD prevalence was associated with higher concentrations of PM
(OR 1.52, 95% CI 1.42-1.62, per 5 µg·m
), PM
(OR 1.08, 95% CI 1.00-1.16, per 5 µg·m
) and NO
(OR 1.12, 95% CI 1.10-1.14, per 10 µg·m
), but not with PM
Stronger lung function associations were seen for males, individuals from lower income households, and "at-risk" occupations, and higher COPD associations were seen for obese, lower income, and non-asthmatic participants.Ambient air pollution was associated with lower lung function and increased COPD prevalence in this large study.
Exposure to particulate matter air pollution (PM) has been associated with cardiovascular diseases.
In this study we evaluated whether annual exposure to ambient air pollution is associated with ...systemic inflammation, which is hypothesized to be an intermediate step to cardiovascular disease.
Six cohorts of adults from Central and Northern Europe were used in this cross-sectional study as part of the larger ESCAPE project (European Study of Cohorts for Air Pollution Effects). Data on levels of blood markers for systemic inflammation-high-sensitivity C-reactive protein (CRP) and fibrinogen-were available for 22,561 and 17,428 persons, respectively. Land use regression models were used to estimate cohort participants' long-term exposure to various size fractions of PM, soot, and nitrogen oxides (NOx). In addition, traffic intensity on the closest street and traffic load within 100 m from home were used as indicators of traffic air pollution exposure.
Particulate air pollution was not associated with systemic inflammation. However, cohort participants living on a busy (> 10,000 vehicles/day) road had elevated CRP values (10.2%; 95% CI: 2.4, 18.8%, compared with persons living on a quiet residential street with < 1,000 vehicles/day). Annual NOx concentration was also positively associated with levels of CRP (3.2%; 95% CI: 0.3, 6.1 per 20 μg/m3), but the effect estimate was more sensitive to model adjustments. For fibrinogen, no consistent associations were observed.
Living close to busy traffic was associated with increased CRP concentrations, a known risk factor for cardiovascular diseases. However, it remains unclear which specific air pollutants are responsible for the association.
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•HBM4EU aims to gather evidence on real human exposures to chemicals in Europe.•The process for developing epidemiological questionnaires within HBM4EU is described.•Challenges found ...during this process were addressed to support future research in HBM.•Procedures for questionnaires design should be standardised across HBM studies.•Readily accessible questionnaires will improve data collection in HBM studies.
Designing questionnaires is a key point of epidemiological studies assessing human exposure to chemicals. The lack of validated questionnaires can lead to the use of previously developed and sub-optimally adapted questionnaires, which may result in information biases that affect the study’s validity. On this ground, a multidisciplinary group of researchers developed a series of tools to support data collection within the HBM4EU initiative. The objective of this paper is to share the process of developing HBM4EU questionnaires, as well as to provide researchers with harmonized procedures that could help them to design future questionnaires to assess environmental exposures.
In the frame of the work package on survey design and fieldwork of the HBM4EU, researchers carried out procedures necessary for the development of quality questionnaires and related data collection tools. These procedures consisted of a systematic search to identify questionnaires used in previous human biomonitoring (HBM) studies, as well as the development of a checklist and evaluation sheet to assess the questionnaires identified. The results of these evaluations were taken into consideration for the development of the final questionnaires.
The main points covered by each of the sections included in HBM4EU questionnaires are described and discussed in detail. Additional tools developed for data collection in the HBM4EU (e.g. non-responder questionnaire, satisfaction questionnaire, matrix-specific questionnaire) are also addressed. Special attention is paid to the limitations faced and hurdles overcome during the process of questionnaire development.
Designing questionnaires for use in HBM studies requires substantial effort by a multidisciplinary team to guarantee that the quality of the information collected meets the study’s objectives. The process of questionnaire development described herein will contribute to improve the harmonization of HBM studies within the social and environmental context of the EU countries.
Physical inactivity is a major risk factor for numerous non‐communicable diseases which dominate the overall burden of disease in Switzerland. We aimed to estimate the burden attributable to adult ...physical inactivity in Switzerland and its three culturally different language regions from a societal perspective in terms of disability‐adjusted life years (DALYs), medical costs, and productivity losses. The burden of physical inactivity was estimated with a population attributable fractions (PAFs) approach. PAFs were calculated based on the prevalence of physical inactivity in the Swiss Health Survey and literature‐based adjusted risk ratios of disease incidence. These PAFs were then applied to the total burden of the diseases related to physical inactivity. Physical inactivity was responsible for 2.0% (95%CI 1.7%‐2.2%) of total DALYs lost and 1.2% (95%CI 1.0%‐1.3%) of total medical costs in 2013. This is equivalent to 116 (95%CI 99‐135) Swiss francs per capita per year. Productivity losses were valued at 117 (95%CI 94‐142) Swiss francs per capita per year. The two diseases which caused the highest economic burden were low back pain and depression. The analysis of regional differences revealed that the per capita burden of physical inactivity is about twice as high in the French‐ and Italian‐speaking regions compared to the German‐speaking region. Reasons include a higher prevalence of physical inactivity, higher per capita health care spending, and higher disease prevalence. Cost‐effectiveness analysis of related interventions should consider regional differences for optimal resource allocation in physical activity promotion policies.
There is a growing body of evidence that exposure to transportation related noise can adversely affect health and wellbeing. More recently, research on cardiovascular disease has specifically ...explored the hypothesis that exposure to transportation noise increases the risk for ischemic heart disease (IHD). Our objective was to review and conduct a meta-analysis to obtain an overall exposure–response association.
We conducted a systematic review and retained published studies on incident cases of IHD using sources of transportation noise as exposure. Study-specific results were transformed into risk estimates per 10dB increase in exposure. Subsequently we conducted a random effects meta-analysis to pool the estimates. We identified 10 studies on road and aircraft noise exposure conducted since the mid-1990s, providing a total of 12 risk estimates. Pooled relative risk for IHD was 1.06 (1.03–1.09) per 10dB increase in noise exposure with the linear exposure–response starting at 50dB. Based on a small number of studies, subgroup analyses were suggestive of higher risk for IHD for males compared to females (p=0.14), and for persons over 65 years of age compared to under (p=0.22). Air pollution adjustment, explored only in a subset of four studies, did not substantially attenuate the association between noise exposure and IHD.
The evidence for an effect of transportation noise with IHD necessitates further research into the threshold and the shape of the exposure–response association, potential sources of heterogeneity and effect modification. Research in different cultural contexts is also important to derive regional and local estimates for the contribution of transportation noise to the global burden of disease.
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•We review and conduct a meta-analysis on transportation noise exposure and IHD.•Novel approach to pool studies with a diversity of metrics and exposure categories.•We verify the assumption of a linear ER association by targeted statistical analyses.•The overall RR is 1.06 (1.03–1.09) per 10dB increase in noise, starting at 50dB.•More studies are needed to refine the shape and threshold for the ER relationship.
Lower respiratory diseases are the most frequent causes of hospital admission in children worldwide, particularly in developing countries. Daily levels of air pollution are associated with lower ...respiratory diseases, as documented in many time–series studies. However, investigations in low-and-middle-income countries, such as Vietnam, remain sparse.
This study investigated the short-term association of ambient air pollution with daily counts of hospital admissions due to pneumonia, bronchitis and asthma among children aged 0–17 in Hanoi, Vietnam. We explored the impact of age, gender and season on these associations.
Daily ambient air pollution concentrations and hospital admission counts were extracted from electronic databases received from authorities in Hanoi for the years 2007–2014. The associations between outdoor air pollution levels and hospital admissions were estimated for time lags of zero up to seven days using Quasi-Poisson regression models, adjusted for seasonal variations, meteorological variables, holidays, influenza epidemics and day of week.
All ambient air pollutants were positively associated with pneumonia hospitalizations. Significant associations were found for most pollutants except for ozone and sulfur dioxide in children aged 0–17. Increments of an interquartile range (21.9μg/m3) in the 7-day-average level of NO2 were associated with a 6.1% (95%CI 2.5% to 9.8%) increase in pneumonia hospitalizations. These associations remained stable in two-pollutant models. All pollutants other than CO were positively associated with hospitalizations for bronchitis and asthma. Associations were stronger in infants than in children aged 1–5.
Strong associations between hospital admissions for lower respiratory infections and daily levels of air pollution confirm the need to adopt sustainable clean air policies in Vietnam to protect children's health.
•Study examined association between ambient air pollution and lower respiratory infection in children.•An eight-year time-series study with 57′851 hospital admissions.•All markers of ambient air pollution were positively associated with pneumonia related hospitalizations.•Associations observed for nitrogen dioxide with pneumonia were independent of those seen for particles.
It has been debated, but not yet established, whether increased airway responsiveness can predict COPD. Recognising this link may help in identifying subjects at risk.
We studied prospectively ...whether airway responsiveness is associated with the risk of developing COPD.
We pooled data from two multicentre cohort studies that collected data from three time points using similar methods (European Community Respiratory Health Survey and Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). We classified subjects (median age 37 years, 1st-3rd quartiles: 29-44) by their level of airway responsiveness using quintiles of methacholine dose-response slope at the first examination (1991-1994). Then, we excluded subjects with airflow obstruction at the second examination (1999-2003) and analysed incidence of COPD (postbronchodilator FEV
/FVC below the lower limit of normal) at the third examination (2010-2014) as a function of responsiveness, adjusting for sex, age, education, body mass index, history of asthma, smoking, occupational exposures and indicators of airway calibre.
We observed 108 new cases of COPD among 4205 subjects during a median time of 9 years. Compared with the least responsive group (incidence rate 0.6 per 1000/year), adjusted incidence rate ratios for COPD ranged from 1.79 (95% CI 0.52 to 6.13) to 8.91 (95% CI 3.67 to 21.66) for increasing airway responsiveness. Similar dose-response associations were observed between smokers and non-smokers, and stronger associations were found among subjects without a history of asthma or asthma-like symptoms.
Our study suggests that increased airway responsiveness is an independent risk factor for COPD. Further research should clarify whether early treatment in patients with high responsiveness can slow down disease progression.
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